🌿 Folk Prescriptions

One, Regarding the Use of Platycodon
Platycodon is commonly used in formulas for exogenous cough. Xu Lingtai repeatedly criticized its use in reviewing *Clinical Guide to Medical Cases*, arguing that Platycodon ascends and is unsuitable for cough patients. Although the Platycodon Decoction (Platycodon, licorice) is a formula from Zhang Zhongjing, it should use more licorice and less Platycodon. The main action of Platycodon is expectorant. Historically, scholars have considered it a "boatman for all herbs" due to its ascending property, but this actually refers only to its expectorant effect. It is appropriate for cough with abundant phlegm. Although Platycodon ascends, when paired with descending agents like Aurantii Fructus or Peucedani Radix, the opposing movements balance the Qi flow, benefiting the chest, throat, and airway. However, it should be avoided in dry cough without phlegm. Golden buckwheat and Polygala are stronger expectorants than Platycodon, and they perform poorly in irritating dry coughs. The usual dosage of Platycodon is 3–6 grams.
Two, Regarding Cough-Relieving Formulas
As previously mentioned, treatment for exogenous cough should focus on addressing the root cause—the essence of TCM's "treating the root cause." This concept is broad; for specific conditions, symptoms (like cough) are the manifestation (the branch), while the cause (such as wind-cold or wind-heat) is the root. Zhang Jiebin said that Yang Qi, Yin Essence, and Stomach Qi are the fundamental causes of all diseases; the initiating factor is the true root. *Lingshu* says, "The ultimate treatment lies in unity; unity arises from understanding the root." Therefore, exogenous cough should be treated according to the six climatic factors, and once the cause is eliminated, cough will cease.
However, even after wind dissipates, cold clears, heat resolves, and dryness restores, cough may persist. At this point, check for concurrent conditions (such as phlegm-dampness, blood stasis, food accumulation) or organ deficiencies (such as spleen or kidney deficiency). If present, treat both concurrently. Deficiency should be prioritized. For example, if persistent cough is accompanied by poor appetite, loose stools, fatigue, and spontaneous sweating with aversion to wind—indicating spleen-lung deficiency—using methods to disperse, descend Qi, and resolve phlegm would further damage already weak spleen-lung function. Instead, shift to treating deficiency, possibly ignoring cough entirely, as Ye Tianshi said: "Having reduced appetite and loose stools, how can one spare time to treat cough?" By strengthening the spleen, tonifying Qi, and warming the lungs, treating the root while neglecting the symptom, cough will naturally subside. Here, the concept of "root" shifts to "disease is the branch, person is the root."
If there are no signs of the six climatic factors, no concurrent conditions, or organ deficiencies, yet cough persists, consider using cough-relieving formulas. In Song and Yuan dynasties, opium poppy shell and winter flower were commonly used. *The Holy Treasury of the Imperial Medical Bureau* frequently used Stemonae Radix (e.g., Stemonae Radix Pill: Stemonae Radix, Winter Flower, Heavenly Gate Winter, Fritillaria, Platycodon, Purple Gromwell—possibly the prototype of Cheng Zhongling’s Cough-Relieving Powder; Stemonae Radix Decoction: Stemonae Radix, Rehmannia, Ginger, Lily, Ophiopogon; Purple Gromwell Powder: Purple Gromwell, Winter Flower, Stemonae Radix). Also, Nine Immortals Powder (Winter Flower, Opium Poppy Shell, Fritillaria, Ginseng, Mulberry Bark, Schisandra, Plum, Donkey-hide Gelatin, Platycodon).
Modern practitioners like Dr. Jiang Chunhua use Stop-Cough Decoction (Nandanzizi, Stemonae Radix, Ma Bo, Tianjiang Ke); for long-term cough with deficiency, remove Ma Bo and add Schisandra. Dr. Yao Shan Zhi uses Cough-Stopping Formula (Roasted Spider, Cicada Skin, Chezi, Zhebei, Chuanbei, Wood Butterfly, Platycodon, Baiqian, Scrophularia, Wild Buckwheat, Forsythia); Dr. Zhang Menglin uses Rapid Relief Cough Decoction (Honey-fried Winter Flower, Honey-fried Silkworm, Chuanbei, Honey-fried Poppy Shell, Platycodon, Whole Scorpion). These prescriptions can serve as references for clinicians. Generally, avoid such formulas if exterior symptoms remain or phlegm is abundant. For long-term cough with deficiency, combine with tonifying treatments.
Nandanzizi is the red fruit of Nandanzhu; adult dose per prescription does not exceed 6 grams. Tianjiang Ke, also known as Tianjiangguo, is the fruit of Morinda, used at three per prescription.
Three, Regarding White Phlegm as Cold, Yellow Phlegm as Heat
This is generally true; textbooks state this, and it is not incorrect. However, judging cold or heat solely by phlegm color is insufficient and may lead to errors. Whether phlegm is white or yellow is not critical; what matters is whether it is thick or sticky. Sticky, thick phlegm indicates true heat. Such phlegm is difficult to expel, and patients often say, "It sticks in my throat and won’t come out." Yellow and sticky phlegm indicates heat; white and sticky phlegm indicates even greater heat. Yellow and thin phlegm, easily expelled, does not necessarily indicate heat—it may simply mean it has stayed in the body longer. White, glue-like phlegm results from body fluids being scorched and concentrated by dry-heat, transforming into sticky phlegm before lingering in the body—thus indicating heat and dryness. Of course, this analysis focuses solely on phlegm, not replacing comprehensive four-diagnosis integration.
Four, Regarding Dryness Pathogen
As previously discussed, autumnal dryness is increasingly common due to multiple reasons. Besides dryness arising from wind carrying warmth or wind-cold transforming into fire and dryness, modern factors include atmospheric pollution, car exhaust, smoking, and living in high-rise buildings. I wish to emphasize distinguishing internal dryness from external dryness. External dryness has two types: first, dry pathogenic factors contracted during autumn; second, pathological changes from wind-cold or wind-heat transforming into dryness. Initially, when the pathogen attacks the exterior, despite dry cough without phlegm, dry mouth, and sore throat, one must still release the exterior pathogen. For dryness caused by cold or heat transformation, clearing heat will naturally relieve dryness; adding slightly nourishing yin and generating fluids suffices. These are all cases of external dryness. Internal dryness differs—it results from depletion of the five zang organs’ essence, blood, and body fluids, though the symptoms resemble external dryness, the severity is far greater. Understanding this clarifies why Yu Shi’s theory focuses on yin deficiency and lung dryness, explaining why Ren Shen (Ginseng) is chosen over Sha Shen (Adenophora) in Qing Zao Jiu Fei Decoction. This formula is not suited for "warm dryness injuring the lung" or "light dispersing lung dryness," but rather for internal dryness in miscellaneous diseases. Twenty-five years ago, while assisting Professor Fang Yuzhong at Xiyuan Hospital, a worker from a Beijing factory with lung cancer came for consultation. His symptoms included dry cough, sticky phlegm in the throat that wouldn’t clear, shortness of breath, and wheezing. Professor Fang prescribed Qing Zao Jiu Fei Decoction with Ginseng, adding Zhebei and Cordyceps powder—results were excellent. I followed up on this case for several years, so the impression remains vivid.
Five, Regarding Throat Itch
Throat itch is common in exogenous cough. Itching belongs to wind, so wind-induced cough, wind-cold cough, and wind-heat cough initially manifest with throat itch. Wind-dispelling herbs like Schizonepeta, Saposhnikovia, Mentha, Arctium, and Cicada Slough can relieve throat itch. When wind-cold transforms into heat, causing wind due to heat, clearing heat will calm fire and stop wind, thus relieving itch. For dryness pathogen injuring the lung, severe dryness leads to dryness and loss of moisture in the airway—use sweet-cool, moistening remedies. For damp-phlegm cough, obstruction of the airway causes upward reversal of lung Qi—lower Qi, transform phlegm, open the airway, and itch will subside. Examples include Aristolochia and Perilla; others like Citrus Peel and Pinellia. Sometimes I also use Buthus and Beehive.
Six, Regarding Constitution
Ye Tian Shi said: "When discussing illness, first assess constitution, appearance, and pulse, because illness is something added to the body." (See *Clinical Guide to Medical Cases*, Case of Cai Old Woman). Therefore, although this article discusses exogenous cough, patient constitution cannot be overlooked. Clinically, constitution largely determines susceptibility to different pathogens and tendencies in pathological changes after illness. Generally, those with plump bodies and soft flesh, having yang deficiency, are prone to dampness and phlegm, and their skin pores are loose, making them more susceptible to wind-cold invasion. Those with lean bodies and dark complexion, having yin deficiency, are prone to dryness and heat, making them more likely to contract wind-heat. Thus, for wind-heat or dry-heat cough in yin-deficient individuals, attention must be paid to yin. As seen in Ye Tian Shi’s prescriptions, ingredients like Polygonatum, Adenophora, Trichosanthes, Ophiopogon, and sugarcane juice are often used—this is the reason. For wind-cold cough in yang-deficient individuals, directly support yang. Zheng Qin’an said yang-deficient individuals always show fatigue, lack of speech, weakness in limbs, dull spirit in person and pulse, pale lips or tongue, preference for hot drinks and food, no fever, spitting white foam phlegm, especially fond of chili and ginger. Supporting yang will naturally stop cough; do not treat phlegm by resolving phlegm or stop cough by suppressing cough. I once treated patients who had coughed for months, triggered by cold wind or cold food. Reviewing their prior treatment, most matched Zheng’s description—medications were merely common ones like apricot kernel, Fritillaria, Purple Gromwell, Winter Flower, Pinellia, South Star, Mustard Seed, Lily, Mulberry Bark, Citrus Red, Perilla, Loquat Leaf—mixed indiscriminately, turning the condition into a "complicated case." Switching to constitution-based treatment, ignoring cough entirely, warming yang and dispelling cold, the cough resolved. This aligns with the earlier idea: "Disease is the branch, person is the root."